Sep 28, 2006 1:30 PM

Does this sound right? I am experiencing pain in the ball of my foot (only one of them) after long runs, and fleet feet said that it was due to my arch not being supported well enough, causing the front of my foot to flex down.

Is this correct? I ended up buying the arch support insert that they reccomended.

I have the same problem. I finally went to the podiatrist and had xrays taken. I was diagnosed with metatarsal capsulitis. The 2nd metatarsal is taking all the pressure when my foot comes down and is causing inflamation in the joint, which is just under my foot pad.

The most common treatment is a footbed insert with padding added to either side of the metatarsa area (the underside) to take the pressure off of the offending joint.

My doc said I won't make it worse by continuing to run, so "run if you feel like it".

I was diagnosed with capsulities mid-December, and while it is better, it's not gone.

I wondered if your capsulitis cleared up, and if so, what helped. Mine is not a bad case, but I'm concerned that if I try to run, I'll make it worse. I was born with flat feet, and have a bunion on the foot with the 2nd-toe capsulitis. The bunion's been there for 30 years, and does not bother me. I have been wearing wide-width shoes for years, and last year got new custom orthotics that helped a knee issue I had (same leg as this capsulitis). I'm currently undergoing "MLS laser" treatment, but it doesnt seem to be helping. Even though I've only been diagnosed for 5 weeks, I'm discouraged.

I know this is a very old thread, and the original posters may no longer be in contact, but you've brought it back to life with your recent post. It's been a while, and I know you had some success with ART, etc., but there have been enough changes in shoes, orthotics, therapy, that for certain parts of your anatomy, it may be like starting over again, as you adapt to each change.

We might have discussed this a while back, but is your foot the Morton type with the longer 2nd metatarsal? Not talking about total toe length, but just the placement of the metatarsal head with respect to the 1st metatarsal head, or big "ball" of the foot vs. the 2nd.

The reason why I ask is that Morton's often goes hand-in-hand with flat feet, 2nd metatarsal pain, foot instability leading to knee problems, etc., because it shifts impact load from the ball of the foot to the 2nd metatarsal (as an orthotic might also do), and can exacerbate arch collapse by tiring the Tibialis Posterior muscle. No doubt, your plantar fascia is also stretched to the point of offering little support. Another contributing factor could be hypermobility, or too much flexibility in the ligaments of your foot.

Of course, the 1st metatarsal head is larger and should bear the lion's share of impact, but this would become more complicated in the case of bunions. It might be tough to sustain a running program with all those complicating factors, without some other pathology creeping up on you.

The challenge for professionals handling your case, is to design a way to spread out the impact across the joints of your foot in a way that replaces the shock-absorption a higher arch would provide. Constantly evolving shoes add to this challenge by changing the way even a custom orthotic works.

I hate to see you going through this, because I know you really care about running. Have you been prescribed any exercises to contribute to the strength of your arch and the stability of your ankle?

My second toe on the foot with capsulitis is longer than the big toe. Not sure how to determine your "placement" description. What makes this particular bout of injury depressing is that I did not get this running. I have not run since March, because of an upper hamstring issue. That took me till Nov/Dec to resolve, mostly because while I quit running, I didnt quit exercise-walking or yoga till after I started PT in October, when the therapist told me to stop. And by golly, between quitting those things and doing the PT exercises, things improved within a couple of months.

The capsulitis pain occurred in mid-Nov, the day after I wore dress flats (wide toe box, have worn them many times before) to an event where I had to walk about 3 blocks to/from on downtown sidewalks. Felt fine at the time, but the next morning woke up with the pain. Lived with it till mid-Dec, when I saw the podiatrist and was diagnosed. I was so depressed, because the hamstring was finally OK, and I was just starting to think about walking for exercise (with running in perhaps a month later) when this occurred.

Had my last "cold laser" treatment today. I am also wearing a toe separator the podiatrist gave me between the 2nd and big toe. Kinda clunky, but I'm getting used to it. I see him again Feb 4. He has not mentioned any foot exercises, and the last time I saw the PT for the hamstring, I told her about this, and she had no suggestions either.

What I am thinking about doing is buying walking shoes wide enough to accomodate Correct Toes. I've tried wearing them a bit here and there, and they feel comfortable and I've read where others wear them walking and running and sleeping. I can get both my walking and running shoes on with them on, but it's tight. I had asked the podiatrist about them earlier, and he said they were fine, but he thought the single separator was better because my problem is just between the first 2, and I wouldnt have to buy new shoes. But I wonder if by wearing the single separator, am I squishing the other toes :-) I dont mind buying wider shoes, if that helps.

Sigh.....I would love to get back to running, or at least walking. I have low goals....I'd be happy with running a 2 miles once or twice a week. I'm trying to remain positive, and remind myself that it could be worse, and that it's only been 5 weeks since the capsulitis diagnosis. It would be great if I could be exercise-walking in March, when our weather begins to be nice...

The longer toe can be a clue, but the best way to determine metatarsal length is to scrunch the toes down in lighting where you can see how the "knuckles" over the balls of the feet line up on the top of your foot. If the 2nd is advanced over the 1st, biomechanical issues can result, running or not. The 2nd bears too much weight in this arrangement as the foot rocks forward during ambulation. It can cause some problems standing because the larger 1st metatarsal is de-emphasized in a way that affects stability.

You're right about the separators, because there is the possibility of creating conditions for a neuroma to develop between the remaining metatarsals if they are crowded. Gonna be hard to find shoes wide enough for full separation, though. I'd say get some Vibrams, but the toe arrangement might not be a good fit for your type of foot. They still make almost all shoes for an "average" foot arrangement that is barely common enough to call normal.

If you were successful at yoga, the required flexibility may extend down to the ligaments of the foot, where too much flexibility can make stability difficult. Not sure what led to the stretched plantar fascia and lax Tibialis Posterior, but a Morton's arrangement doesn't help. I'd avoid flats in the future if you are set up this way. Footwear is going to be the biggest challenge going forward in your case. Keep them working on it.

There is the possibility that shortened hammies may have altered your gait in such a way that a few blocks of walking in unstructured shoes did a little damage, but I would expect that effect to be temporary. If the hamstrings are back to normal and you're out of dress shoes, I would expect progress.. maybe not soon enough for training goals, but we all go through that every now and then.

Sounds to me like you are actively involved with your recovery plan, so don't be discouraged. Your hope and persistence will pay off. Good luck!

I'm feeling better today, because the foot/toe is feeling better, so perhaps I'm on the road to recovery. Gosh that would be great.

Re getting wide-enough shoes, if I have trouble with womens, I thought I might investigate mens. And luckily, I'm retired, so I dont have to wear dress shoes often :-) And hamstrings are doing fine, so that's another positive.

When you say "footwear is going to be the biggest challenge," I agree with you, and recall the issues my mother had (I got these feet from her). But fortunately for me, I have sooooo many more options than she did, so I am thankful for that and optimistic about finding something that will work for me.

In the meantime, I will try to be patient, rest my feet as much as possible, and will see where I am on the 4th when I meet with the podiatrist.

Because you were helpful earlier, I wanted to give you an update. I actually ran 2 miles on the treadmill yesterday!

I think what ultimately helped is time and rest, probably more than anything. My foot/toes became pain-free about 10 weeks after diagnosis. I need to be more patient when injured :-)

Other changes I made - I got revised orthotics. The people who made them a year ago extended the hard portion, they called it a "post." Also, I am wearing the toe separator between the big and second toes given me by the podiatrist, and I wear Correct Toes a few hours a day around the house (do not wear them in shoes outside the house). I added a couple of foot/toe stretches to my after-run routine, and also always ice after activity now, which was recommended by the podiatrist. Occasionally I have a twinge of pain in the foot, but the twinges are minor and fleeting.

I'm going to stay at 2 miles, 3 times a week, for awhile, to get more comfortable cardio-wise, and to make sure I can sustain even this small amount without injury. I plan to work up to my usual 3-miles later.... Even though 2 miles is short, it is alot to me, and I am thrilled to be running again!